The Problem of Accessing Health Care 

By Michelle Meadows


Closing the Gap, The Problem of Accessing Health Care • August/September 1999


Paying for family health insurance would have lopped off $200 

from each paycheck, said Glynis, a 35-year-old African American beautician in Maryland. “The options through my company were outrageous,” she said. “That’s about $400 a month that we 

really needed.” So she and her three children lived without coverage 

for seven years. 

“When my kids needed shots, I took them to free clinics,” she 

said. “If they had to go to the emergency room, then I’d just end up 

“A main reason is that many Hispanics work in industries that 

don’t offer health benefits,” said Joan Jacobs, a policy analyst in the 

Office of Minority Health’s Division of Policy and Data. According to 

the National Council of La Raza, many Hispanics are employed in 

manual labor and service occupations. More white men and women, 

however, are concentrated in managerial and professional specialty 

occupations. 

According to E. Richard Brown, PhD, director of UCLA’s Cenwith a big bill.” Fortunately, 

one of her customers recently 

told her about the new Maryland Children’s Health Insurance Program (see CHIP article on page 3 of issue). 

Now, Glynis buys her 

individual health insurance 

through the hair salon at a 

“Though the differences in insurance rates between Hispanics 

and other Americans are striking, racial and ethnic minorities 

generally fare worse than whites—a fact that often goes 

unmentioned in health coverage debates.” 

ter for Health Care Policy Research, many Latino immigrants come to this country 

with low levels of education. 

“That is often exacerbated 

by a non-citizen status,” he 

said. Many are scared to apply for health services for fear 

of possible penalties by the 

price of $54 every two weeks. And her kids are covered through the 

Maryland program, which provides comprehensive services for eligible children and pregnant women in families with an income at or 

below 200 percent of the federal poverty level. 

Experts say such insurance programs are critical because even 

though our economy is booming, lack of health insurance remains a 

significant problem. Americans at the bottom half of the income distribution feel the hardest hits. 

Many under the median income of $35,000 are uninsured, go 

without the care they need, have trouble paying medical bills, and 

report poor health, according to a new study called, Can’t Afford to 

Get Sick: A Reality for Millions of Working Americans. The report is 

based on The Commonwealth Fund 1999 National Survey of Workers’ Health Insurance (http://www.cmwf.org). 

For many, the problem involves not having the option of obtaining health insurance from their jobs. According to the Commonwealth Fund study, two of five workers with incomes less than $20,000 

either weren’t offered a plan through their employers or weren’t eligible to participate. For others like Glynis, the only options are too 

expensive. 

Hispanics are least likely to be insured 

According to the Commonwealth Fund report, Hispanics were 

generally at high risk of being uninsured and lacking access to employer plans. That’s in sync with the Health and Human Services’ 

Agency for Health Care Policy and Research (AHCPR) report, Racial 

and Ethnic Differences in Health 1996. Released earlier this year, the 

report found that more than one-third of Hispanics had no insurance 

coverage. While Hispanics represent 11.6 percent of the U.S. population under age 65, they make up more than 21 percent of 

the uninsured. 

Immigration and Naturalization Service (INS), he adds. (See INS article on p. 14 of issue). 

Though the differences in insurance rates between Hispanics 

and other Americans are striking, racial and ethnic minorities generally 

fare worse than whites—a fact that often goes unmentioned 

in health coverage debates, Dr. Brown said. His center recently 

released results from state studies that showed that while 76 percent 

of white non-elderly Californians had private health insurance in 

1997, only 43 percent of Latinos, 60 percent of African Americans, 

and 65 percent of Asian Americans and Pacific Islanders were privately insured. As a result, minorities are at greater risk of being uninsured altogether. 

“For Asians and Pacific Islanders, it’s important to understand 

the differences between subgroups,” Dr. Brown said. For example, 

those populations who are more acculturated into the American society, such as the Japanese, tend to have higher levels of education and 

health coverage comparable to whites. But newly arrived immigrants, 

such as those from Southeast Asia, have lower education levels and 

much higher uninsured rates than whites.” UCLA’s Center for Health 

Policy Research will release a national study in October. Look for it on 

the Web: http://www.healthpolicy.ucla.edu. 

Insurance isn’t the only barrier 

A basic issue in health care access is coverage versus no coverage, 

OMH’s Jacobs said. “Then we have to look at the fact that when there 

is coverage or when care is available, many Americans still aren’t getting it. Access to insurance doesn’t necessarily mean access to care, or 

even high-quality care for that matter.” 

Carrie Jones, executive director of the Family Services Institute, 

Wichita, KS, said she finds that residents in her area face 

continued on page 2>>>> 

Office of Minority Health Resource Center 1 U.S. Department of Health and Human Services 
The Problem of Accessing Health Care 

By Michelle Meadows


Closing the Gap, The Problem of Accessing Health Care • August/September 1999


considerable transportation barriers. Through the Institute’s Black 

Infant Mortality Project, case workers use community outreach to 

help African American women navigate the health system and get 

their babies off to a healthy start. “Many women don’t have cars or 

have to deal with our limited public transportation system,” Jones 

said. “So we go pick them up and take them to appointments because 

that’s the only way they’ll get there.” Jones said one woman died in 

her home during labor because she couldn’t get to a hospital. “She 

didn’t even have a phone to call for help.” 

Other times, women don’t know about available services. “The 

free clinics are there, but they might not know it,” Jones said. “So we 

do a lot of connecting—connecting them to the providers and helping them with the paperwork they have to fill out to obtain services.” 

Sometimes, women start to fill out papers and then put them aside 

because it’s too much to deal with. 

For minorities, it’s important that programs are offered in a community setting that makes them comfortable, Jones said. That could 

involve speaking the right language, respecting a patient’s cultural 

beliefs, or using appropriate body language. “But it has to be a culturally sensitive environment,” Jones added. “And we’ll get the best results, if the decision-makers find out from the community what the 

community needs.”

Office of Minority Health Resource Center 2 U.S. Department of Health and Human Services